Families agonize waiting for nursing homes to reopen for visitors amid coronavirus outbreak.

Jun. 4--When Jackie Saldana saw her 77-year-old father for the last time on March 13, the Glenhaven Healthcare nursing home in Glendale was just days away from locking its doors to the public to protect patients from the novel coronavirus.

At the time, Ricardo Saldana was in stable condition undergoing long-term care for a stroke he suffered in 2014. But within weeks, his daughter learned the nursing home had placed a resident who had been exposed to the virus in the same room with her father.

By April 8, Ricardo Saldana had developed pneumonia and was transferred to a hospital, where he tested positive for COVID-19. A few days later, he was dead.

"When they told me my dad passed away, I screamed and felt like a hundred knives went through my heart," Saldana said, her voice breaking up.

She is among the thousands of people whose family members have been locked in nursing homes -- many of them battered by the novel coronavirus -- wondering if they ever will be able to see their relatives again.

As California begins to emerge from its two-month stay-at-home orders -- reopening malls, restaurants, churches and hair salons -- it's clear nursing homes and other long-term care facilities won't be lifting their restrictions anytime soon given what hotbeds they have become for COVID-19.

As part of the White House's Opening Up America Again plan, the Centers for Medicare and Medicaid Services recently issued guidelines urging governors to use caution with nursing homes, saying they should continue to ban visitors unless all residents and staff have tested negative for the coronavirus for at least four weeks.

They also will be expected to have enough protective gear for staff and residents, access to broad COVID-19 testing and be located in an area where there is sufficient space in intensive care units at nearby hospitals.

Could the wait last years?

But advocates and families say the criteria are impossible to meet.

Mike Dark, a lawyer with the nonprofit group California Advocates for Nursing Home Reform, said "because of limited testing, and because the virus is so widespread, that will mean no visitors for a long time, maybe years."

The crisis is likely to continue unfolding over the next year, Dark said. "At what point are family members going to be able to start getting back into facilities? And what's crucial is it can't wait until the crisis is over because the need is right now."

Families provide not just moral support, but they often are the ones ensuring their loved ones are getting basic care, are fed properly and are checked for things like bed sores, Dark said, adding that "none of that has been able to happen for nearly two months."

The federal guidelines require nursing homes to have "sufficient staffing," he added, before families can visit their loved ones.

Families paying the price

"The problem is that it will never happen," Dark said. "It will never happen because there was never sufficient staffing even before the crisis. There's still little access to testing and those are things that CMS should've been on top of and wasn't. The federal regulators are asking families to pay the price for those failures. And it's not fair and many people will die as a result."

Experts argue that a limited number of visitors with protective gear should be allowed in nursing homes.

"We really need to be doing everything we can to bring socialization to residents," said Michael Wasserman, a geriatrician and president of the California Association of Long Term Care Medicine, which represents nurses, doctors and others working in long-term care facilities. He added that social isolation has proved to be just as dangerous as the virus.

The greatest challenge, he said, is making sure the nursing homes are testing all of their staff at least every one or two weeks.

Nearly 3 million tests would be needed to cover every nursing home resident and staff in the U.S. With an estimated cost of $150 per test, testing all 1,193 facilities in California -- with 103,480 residents and 139,060 employees -- would require 242,540 tests and cost about $36 million, according to the data compiled by the American Health Care Association and National Center for Assisted Living.

"Once the virus gets into a nursing home or assisted living, it kills people," Wasserman said, adding that facilities need to focus on testing employees who work at multiple locations and can pick up the virus at one and bring it to another.

Many nursing homes currently rely on checkpoints to screen employees when they enter facilities, asking if they have symptoms and taking their temperature. But those guidelines proved to be a failure as people without symptoms were able to carry the virus and transmit it to others.

In California, experts estimate nearly 50% of all COVID-19 deaths stem from long-term care facilities, including nursing homes. Nationwide, studies place the figure at about 42%. Locally, the city of Pasadena says 90% of its COVID-19 deaths stem from nursing homes.

Ferrer: 'We were wrong'

Barbara Ferrer, the county's public health director, announced on April 22 that her department had been misguided to focus testing only on symptomatic patients at nursing homes and said the county has an obligation to test all residents and employees.

"It turns out, we were wrong," Ferrer said. "With new information, it has become clear that asymptomatic people are capable of spreading the virus."

But the damage has already been done, particularly in long-term care facilities where asymptomatic workers unwittingly infected those they were taking care of.

In Riverside County, roughly 80 patients had to be evacuated from the Magnolia Rehabilitation and Nursing Center in April after more than a dozen employees stopped coming to work amid an outbreak.

Wrongful death suit

On May 21, Saldana and her family filed a wrongful death lawsuit in Los Angeles Superior Court alleging Glenhaven Healthcare nursing home committed elder abuse, willful misconduct and negligence in its COVID-19 response, resulting in the death of her father and several other residents. The lawsuit alleges the facility failed to provide face masks to employees and prohibited workers from bringing or wearing their own protective equipment until it was too late.

During her visits to Glenhaven Healthcare, Saldana said, she observed the same scene with workers being "busy and careless."

"I was helping (my father) and it was not even my job," she said.

Carrie Marks, an administrator with Glenhaven Healthcare said, said in a statement that due to federal and state privacy laws, "we are absolutely prohibited from discussing any alleged current or former patient of our facility. In fact, we are unable to confirm whether any individual is or was a patient at our facility."

Marks added: "We can definitively say that Glenhaven Healthcare heroes put our patients first every day. Our nurses are trained on and follow applicable guidelines from the Department of Public Health and the CDC."

As of May 28, 15 staff and 19 residents at Glenhaven Healthcare had contracted coronavirus and five people had died, according to the Los Angeles County database of nursing home facilities.

Others in same shoes

For all of the Jackie Saldanas grieving the loss of loved ones who died in long-term care facilities, there are thousands more fighting to ensure they don't suffer the same fate.

Debra Merrill of Santa Monica is anxiously waiting to reunite with her 88-year-old mother, Dorothy, who resides in the Rehabilitation Center of Santa Monica, after a weeks-long separation.

Her mother, who is paralyzed on the right side, requires constant attention, Merrill said. Knowing that the facility is "grossly" understaffed, she said it's "terrifying" that she can't see her in person.

"The families keep an eye on patients," she said. "Now, you don't know what's going on there. I don't think they mean any harm. They are understaffed and they don't pay their staff well enough. They don't know what they're doing."

Merrill said: "My biggest fear is if she dies and I won't be there with her" and won't get a chance to say goodbye.

Limited visits?

During a daily briefing on May 21, Ferrer said her team is working to come up with a policy that would allow families -- in a limited number -- to visit nursing facilities, "particularly those where there's no other way to communicate" with residents.

Frank Kim, Orange County's executive officer, said he doesn't yet have a timeline for reopening nursing homes. And since they are privately operated, he said, they will each determine when to provide "additional or increased access to family members and others to visit their loved ones."

Representatives with Riverside County said they don't have any additional restrictions other than the state's stay-at-home orders. San Bernardino County officials were not available to discuss their plans.

Because of the virus, Saldana and her family were not allowed to be near her father even after he died. A funeral home sent her a photo of Ricardo Saldana in his casket to confirm his identity. A few days later, she drove to a cemetery with her family and stayed inside her car, watching as cemetery workers lowered his casket into a grave.

"That was our funeral," she said. "He was a great father and a great husband. He will be missed."

Staff Writers Brenda Gazzar and David Rosenfeld contributed to this report.

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